Healthcare Provider Details

I. General information

NPI: 1083785372
Provider Name (Legal Business Name): DIGESTIVE DISEASE MEDICINE OF CENTRAL NEW YORK, LLP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/10/2006
Last Update Date: 06/19/2020
Certification Date: 06/19/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

116 BUSINESS PARK DRIVE 1ST FLOOR
UTICA NY
13502-6313
US

IV. Provider business mailing address

116 BUSINESS PARK DRIVE 1ST FLOOR
UTICA NY
13502-6313
US

V. Phone/Fax

Practice location:
  • Phone: 315-624-7000
  • Fax: 315-793-1129
Mailing address:
  • Phone: 315-624-7000
  • Fax: 315-793-1129

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM2500X
TaxonomyMedical Specialty Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: BRADLEY F SKLAR
Title or Position: OWNER
Credential: MD
Phone: 315-624-7000